Opioids do nothing to heal what causes pain; they simply prevent the news of it from reaching the brain.
In doing so, they also affect brain centres that control pleasure and reward, producing euphoria and a sense of comfort (often along with some unpleasant side-effects, from drowsiness to constipation and nausea).
Chemically very similar, the various offspring of opium also slow the heart rate and breathing, and can, if taken in too great a quantity, lead to unconsciousness or death.
Starting with morphine in 1804, followed by heroin 70 years later and oxycodone during the First World War, they have evolved in large part because of medical science’s quest for something less addictive to kill pain.
Until recently, opioids were largely administered as short-term relief to people experiencing intense, excruciating acute pain, including cancer patients, people who were dying or those recovering from surgery.
The landscape shifted dramatically in the mid-1990s, when the U.S. and Canada approved a new drug called OxyContin. It contained oxycodone, but was unique: the first-ever controlled-release opioid, meaning its analgesic effects could be delivered over the course of a day, eliminating the need to take a pill every few hours.
OxyContin was seen as a revolution for the management of moderate to severe chronic pain (Health Canada says there are now 38 controlled-release opioids on the market), but it didn’t take long for problems to appear.
Being once a day, each OxyContin pill contained a lot of the active ingredient. People soon discovered that, if chewed or snorted, the pills released their full effect at once, producing such a euphoria that the drug was soon better known as “hillbilly heroin.”
TWO CASE HISTORIES
Glen Levy, Amherst, N.S.: ‘We have opened Pandora’s box – it’s going to haunt us’
Despite his training as a pharmacist, Glenn Levy was oblivious to the fact that he would spend his days, telling customers how to take pills properly, then drive home and pop enough painkillers to turn himself into a zombie.
He would sit in the basement for hours staring into space only to do it all over again the next day.
The problem began in 2005 when he underwent major spinal surgery and was prescribed Dilaudid, whose active ingredient is hydromorphone, a powerful opioid. Designed to provide relief for hours on end, and available in very high doses, it not only eased his physical pain but restored a sense of well-being he’d lost while volunteering in New York after 9/11.
“Even with all the knowledge that I had, you don’t for a minute think it’s going to affect you…,” he says. “I had no idea how powerful, how strong they were.”
Soon, his doses began to increase, and he gave up playing guitar in a jazz band, as well as golf and volunteer work. He concealed his habit well (“We picture an addict as someone in an alleyway with a needle and dirty water,” he says), but eventually his relationship with his wife and children fell apart and, at the end, he could barely function work.
Finally, on June 25, 2010, he overdosed – and survived only because his wife was there to call for help. All he can remember is struggling with paramedics as they strapped him to a stretcher.
He spent a month in hospital, having seizures and unable to say his own name, but even after being discharged, still didn’t consider himself addicted. Most of the pills had been prescribed by a doctor who had known him for years and was certain they were just what he needed.
Today, at 54, he is still grappling with the fallout – divorce and little contact with his children – but is off opioids, and in regular therapy with other health professionals recovering from addiction and enjoying life again.
But he warns that lives will be ruined until prescribing is scaled back dramatically.
“We have opened Pandora’s box – it’s the thing that’s going to haunt us.”
Rachel Kilback, Kamloops, B.C.: ‘I was barely existing. I never left my house. I was on drugs all the time. I didn’t think I could cope’
To a casual observer, life was good to Rachel Kilback. The valedictorian for her graduating class, she had gone on to university and married her high-school sweetheart. But all the while she was taking drugs – powerful painkillers prescribed by her doctor to combat endometriosis, an excruciating and incurable affliction of the uterus.
As the years passed, the pills made her physical condition bearable and even eased the depression and anxiety that plagued her – but all at a price.
She began to sleep 18 hours a day, with any waking time spent in a fog. Her husband was left to do all the cooking and cleaning as well as be her nurse.
“I was barely existing,” Ms. Kilback recalls. “I never left my house. I was on drugs all the time. I didn’t think I could cope.”
But when her family suggested that she’d become a slave to her pills, she was furious.
“I didn’t see how a medication I was prescribed could cause that to happen,” she says. “I was supposed to take it.”
Over time, her tolerance grew and the medication became less effective, so the dosage was increased. Finally, in 2011, she managed to escape its grasp with the help of extensive counselling and buprenorphine, a drug used to wean people off addictive substances.
Ms. Kilback says she wishes that someone had warned her how powerful opioids could be. Now she copes with her pain by taking over-the-counter painkillers when needed, using breathing exercises and finding activities she enjoys to channel her feelings, like painting and sculpting.
She also puts her personal experience to use as an addiction counsellor, seeing about 10 people a week seeking treatment for opioid dependence.
“I don’t think we have a handle on this at all,” she says. “There is no control right now.”